Restorative Thresholds Research Articles

A qualitative analysis of dentists’ understanding and management of non-carious cervical lesions (NCCL)

IntroductionNon-carious cervical lesions (NCCLs) are considered to have a multi-factorial aetiology and their management is affected by a range of variables perhaps most importantly clinical judgement. The aim of this study was to elicit information from practicing dentists, using interviews, to explore their understanding of NCCL aetiology, the decision-making criteria of when to restore, and the restorative techniques used to restore NCCLs. This may help identify gaps or anomalies in our understanding to inform future research and clinical practice for the management of NCCLs. MethodsAn interview guide was developed from a literature search which formed 2 domains framed around understanding and management of NCCLs based on: understanding of diagnosis and aetiology, and factors affecting decision making for management. Practicing dentists with more than 10 years of experience were purposively recruited to conduct in-depth, semi-structured interviews. Fifteen interviews were audio recorded and transcribed verbatim. A thematic content analysis was conducted and the results analysed. ResultsFrom the thematic analysis, 2 domains were identified. In the domain of “diagnosis and aetiology”, while participants have similar understanding and methods of diagnosing NCCL, most stated NCCLs in a patient were caused by a “main aetiology” such as “abrasion”, “abfraction” while few described the inter-relationship of these aetiological factors.In the domain of “factors affecting decision making”. “Patient reported symptoms” and “lesion dimension” were the main factors that affected participants’ decision to provide restorative or non-restorative management. However, a “restorative threshold” was not able to be identified. ConclusionThere was notable variety in participants’ understanding of the aetiology, management, and treatment of NCCLs, particularly the restorative threshold of when to treat. Clinical significanceThe variability demonstrates the need to have a clearer understanding of the key elements that affect the management of NCCLs and better information to support the decision of when to treat.

The role of state-of-charge management in optimal techno-economic battery energy storage sizing for off-grid residential photovoltaic systems

With increased photovoltaic (PV) penetration in residential areas, an off-grid PV system is a sustainable solution to meet the zero net emissions goal by 2050. However, an off-grid PV system has a significant technical issue: low power supply reliability. Typically, battery energy storage (BES) is necessary to overcome the technical issues associated with PV systems. Conventionally, BES is operated to maintain a power balance between generation and load. However, techno-economic feasibility is a crucial aspect of BES adoption. Although BES can effectively support off-grid PV systems, it may not be available when its state-of-charge (SoC) reaches the minimum allowable limit, creating power supply failures (outages). Therefore, this study proposes, for the first time, a BES power control strategy that collaborates with SoC management to improve the reliability of an off-grid residential PV-BES system. A simulation study is performed using a residential load profile from the urban area of Bangkok, Thailand, obtained from the Metropolitan Electricity Authority (MEA). A comparative study is conducted to compare the proposed strategy’s performance with that of the conventional control strategy. Following the comparative study, the role of SoC management in BES sizing is quantitatively illustrated. Moreover, the impacts of SoC management parameter setting (i.e., SoC restoration threshold and maximum SoC restoration power) are evaluated using techno-economic performance indicators. The simulation results reveal that BES power management with SoC management could reduce BES capacity and levelized cost of energy (LCOE) by 28% and 26.28% compared with the conventional strategy.

Vegetation restoration thresholds under different vegetation types and altitude gradients in the Sichuan-Yunnan ecological shelter, China

Determining the threshold for the response of ecosystem services (ESs) to vegetation change is critical for ecological restoration, and once the threshold is exceeded, ESs may be inhibited. Vegetation type and altitude are important factors affecting ESs. However, the nonlinear effects of vegetation change on ESs and their threshold under different vegetation types and altitude gradients are not clear. This study selected the Sichuan-Yunnan ecological shelter as the study area. Four ESs (water yield (WY), carbon storage (CS), soil conservation (SC), and water purification (WP)) were quantified by using the Integrated Valuation of Ecosystem Services and Trade-offs model. The differences in ESs among different vegetation types were identified. Variance analysis was used to explore the spatial differences in ESs under different altitude gradients. The inflection point of the promoting effect of vegetation cover on ESs was taken as the threshold, and elastic analysis was used to determine the impact threshold of fractional vegetation cover (FVC) on ESs. The threshold represents the inflection point at which vegetation cover promotes ESs. The results showed that the CS, SC, and WP of the natural forest were higher than those of the plantation, while the WY was lower than that of the plantation. WY, CS, and SC remained higher in the high-altitude regions, while nitrogen export was higher in the low-altitude regions. FVC was positively correlated with nitrogen export in the low-altitude regions and negatively correlated with WY in the high-altitude regions. FVC had a promoting effect on ESs, and the promoting effect was weakened beyond the threshold. The thresholds of FVC promoting ESs were 0.86, 0.79, 0.85, and 0.83 in natural forest, shrub, plantation, and grassland, respectively. The threshold of FVC promoting ESs in low-altitude regions was larger than that in high-altitude regions. This study can provide a theoretical basis for large-scale ecological management and moderate restoration.

The effect of SoC management on economic performance for battery energy storage system in providing voltage regulation in distribution networks

Nowadays, distribution networks experience voltage deviation and violation issues owing to the increased penetration of photovoltaic (PV) generation. The battery energy storage system (BESS) deployment is a promising solution in providing voltage regulation. However, the economic performance of BESS for voltage regulation provision cannot be ensured when state of charge (SoC) management is considered. Therefore, this study assessed the effect of SoC management on economic performance for a BESS in providing voltage regulation in a distribution network. Five different SoC management scenarios proposed in the literature were implemented with a droop-based voltage regulation strategy. A techno-economic model was developed to determine the advantages and disadvantages of those SoC management scenarios based on cost-attractiveness and profitability. In addition, a sensitivity analysis was conducted to examine the extent to which the net present value (NPV) was affected by changes in SoC restoration thresholds. The results show that the NPV increased substantially when the SoC management scenarios (except the dead-band SoC restoration) were considered. Nevertheless, the levelized cost of energy (LCOE) did not display the economic feasibility of the BESS projects because the remuneration of capacity performance was omitted. Moreover, a significant increase in NPV was indicated for wider SoC restoration thresholds.

The responses of three dominant species to increased rainfall under different grazing systems in a desert steppe

AbstractCompared with drought stress, our knowledge about the potential precipitation increase in desert steppes and its ecological effects is still limited. In order to improve our understanding of the responses of desert steppe plants to climate change and human activities, we performed a 3‐year‐long controlled water addition experiment in grasslands with different grazing systems. The results showed that increased water changed the plant height/above‐ground biomass/leaf‐tissue thickness of Stipa breviflora Griseb., Cleistogenes squarrosa (Trin.) Keng and Convolvulus ammannii Desr. by +23.86%/+77.35%/−19.09%, +14.67%/+162.34%/−16.62% and + 29.14%/+69.37%/−22.85%, respectively, compared to those in the control group. The net photosynthetic rate, stomatal conductance, transpiration rate and water‐use efficiencies of these three types of plants increased by 0.32%–43.71% with water addition, compared to the corresponding parameters in the control group. We also found that plant responses to increased rainfall were not always positive. Under the unique environmental conditions of desert steppes, increase in rainfall has a limited restorative effect on vegetation and an excessive increase in rainfall may actually inhibit plant growth and exacerbate grazing grassland degradation. Compared to rotational grazing and continuous grazing grasslands, plants in enclosed grasslands had higher restoration thresholds and better restorative effect following increased rainfall. Enclosure increased the adaptability and resilience of grazing grassland plants towards increased rainfall. Under the background of increased rainfall, while we look forward to the ecological restoration in desert steppe, we also need to be alert to the potential adverse effects of excessive rainfall on grazing grasslands.

Optimal sampling-based sequential inspection and maintenance plans for a heterogeneous product with competing failure modes

Many products are stored for a long period of time before being used. Such products may experience on-shelf degradation and failure, and thus require repeated inspections and maintenances (IMs) to guarantee their reliability for future uses. However, for products with multiple failure modes, it may be economically impractical to inspect and maintain all the stored units with respect to all the failure modes. In this study, we propose and design dynamic sampling-based sequential IM plans for products that are subjected to competing failure modes during storage. The IM plans inspect a sample of stored units on their performance with respect to specific failure modes, followed by imperfect maintenance. The optimal IM plans aim to optimally balance the availability of heterogeneous units and the use of IM resources under flexible scenarios, by determining the (i) characteristics of the samples for inspections and (ii) product's maintenance and restoration thresholds. A numerical example on a type of airbag is provided to illustrate the efficiency of the proposed IM plans, and IM scenarios that should be employed under different circumstances are recommended.

Decisiones sobre los criterios de diagnóstico y tratamiento de la caries dental entre un grupo de estudiantes de odontología, profesores y odontólogos de la ciudad de Medellín, Colombia.

Objective: To analyze the criteria for diagnosis and treatment decision-making in relation to dental caries in different participants (teachers of dentistry, dental students at dental schools, and dentists practicing at public oral health services) in the city of Medellin (Colombia). Material and Methods: A cross-sectional study was applied in the period September 2015-december 2016 by means of an international validated questionnaire in 340 participants (dental teachers: 69, dental students: 193, dentists: 78). The survey addressed several topics related to detection and restorative threshold, preferences of preparation type, restorative materials used and opinions about diagnosis and treatment for dental caries. A descriptive analysis was carried out and Chi square tests were applied to observe statistically significant differences between the study variables. Results: 340 participants were surveyed among teachers who teach cariology, health care dentists, and undergraduate final-year students. Most participants were women (70%). The age mean was higher for DDSs (46 ± 9 years). On average, practicing dentists and dental teachers had a work experience of 21 ± 9 years. In case of treatment decisions, the majority of the surveyed would use immediate operative restorative treatment for advanced carious lesions (inner one-third of the dentin for approximal and grade 5 for occlusal). In addition, respondents reported different cavities diagnosis for clinical occlusal cases and some significant statistically differences were found for restorative treatment decisions and type of materials according to the type of participant. Conclusion: Criteria for diagnosis and treatment of dental caries differed among the student, dentist and dental teachers with variety in diagnosis and treatment concepts. However, a conservative tendency for restorative treatment decisions was observed. Strategies for incorporating non-restorative and minimal measures in professional practice should be considered in curricula of universities.

Variability in caries management decision-making in a dental school setting.

To assess variability in caries management decision-making by faculty and dental students. Understanding sources of variability during training can aid in implementing evidence-based clinical decision-making in caries management. A voluntary, anonymous survey including clinical scenarios was distributed online to dental students in their first (D1) and third-year (D3) of training, and to faculty in the Department of Cariology, Restorative Sciences and Endodontics. The response rate was100% (108/108) for D1 students, 56% (73/130) for D3 students, and 39% (34/88; 12 full-time and 22 part-time) for faculty. D1 students, who were completing a cariology course, were in general more conservative in restorative thresholds for less severe caries lesions than D3 students and sometimes clinical faculty (e.g., for lesions at the DEJ, a significantly [p<0.05] higher percentage of D3 students would restore these [53%] compared to D1 students and faculty [19% and 18%, respectively; p>0.05]). For all groups, the threshold for doing restorative intervention was shifted toward less severe caries lesions as the caries risk increased (e.g., very few respondents would restore an occlusal lesion confined to enamel, with significantly [p<0.05] less percentage of D1 students [lower risk scenario-LR=4%; higher risk scenario-HR=22%] compared to D3 students and faculty [LR=15% and 18%; HR=66% and 62%, respectively; p>0.05]). Class lectures/preclinical instructors were the most important factor influencing decision-making for D1 students, versus clinical experiences/instructors for D3 students. Although the majority of respondents used best-evidence deciding caries management, there was variability in how to manage less severe lesions, with caries risk influencing clinical thresholds, and clinical experiences influencing students' decision-making over time.

Knowledge and Opinions of French Dental Students Toward Occlusal and Proximal Restorative Thresholds.

To investigate the practices, knowledge and opinions of French dental students (FDSs) in various domains of minimal intervention (MI) in cariology. A cross-sectional, questionnaire-based study was conducted in spring 2018 among all fifth-year French dental students (FDSs) from the 16 French dental schools. The present article focuses on restorative management. Statistical analyses (descriptive, chi-squared) were performed. The response rate was 84.5%. Overall, 97.4% of respondents would have operatively intervened for proximal and 83% for occlusal carious lesions, respectively, while non-or micro-invasive intervention would have been possible. Interestingly, 15% would completely open the occlusal fissures. For both occlusal and proximal lesions requiring a restoration, composite resin was indicated by over 95% of the respondents. In a clinical case, 51.6% of FDSs who rightly diagnosed an enamel carious lesion would operatively intervene. When FDSs could not diagnose the type of carious lesions, a high proportion of invasive actions were also reported (40%). FDSs who read scientific articles were more likely to consider the high importance of not filling sound teeth unnecessarily (p = 0.033). FDSs do not have sufficient awareness of MI guidelines regarding occlusal and proximal restorative thresholds. Efforts are required in dental schools to teach FDSs to postpone invasive/restorative strategies to later stages of carious progression. There is a need to strengthen prevention techniques and non-invasive options in the teaching of MI in cariology.

Restorative thresholds for primary and permanent molars in children: French dentist decisions.

Worldwide, numerous surveys have investigated practices and knowledge about caries management in adults, but few are available for children. The present cross-sectional survey aimed to assess the restorative thresholds (RTs) in primary and permanent molars in children used by a population of dentists treating children and practicing in France. The study population consisted of French dentists treating children (Fr-DTCs) who were registered in the French Society of Pediatric Dentistry (n=250). A specific questionnaire was developed. Descriptive and statistical analyses were performed. Response rate was 80.4% (n=201). Considering that an appropriate RT is at the stage of a moderate lesion (occlusal: International Caries Detection and Assessment System 4; approximal: lesion involving the external third of dentine), more than 50% of respondents showed a tendency for iatrogenic treatment, except for occlusal carious lesions in primary molars. Inappropriate invasive strategies were more often reported for occlusal lesions in permanent than primary molars. Moreover, for both molar types, these inappropriate RTs were more often chosen for approximal than occlusal lesions. The present survey suggested that Fr-DTCs tend to overtreat in terms of caries management in both primary and permanent molars.

Restorative thresholds for carious lesions in primary molars: French dentist's decisions.

Questionnaire surveys have been undertaken worldwide to investigate practices and knowledge related to carious lesion management, particularly in adults. The primary objective of this cross-sectional survey was to investigate restorative thresholds (RTs) used for carious lesions in primary molars by dentists practising paediatric dentistry in France. Dentists were surveyed by a specifically developed questionnaire based on clinical and radiographic caries classifications. The secondary objective was to explore restorative management strategies in primary molars. A structured questionnaire assessing RTs and management strategies for occlusal and approximal carious lesions of primary molars was anonymously and electronically administered via SurveyMonkey® to dentists who were members of the Société Française d'Odontologie Pédiatrique. Descriptive analyses, Chi-square test, McNemar test, and logistic regression analyses considering dependent RT variables for occlusal and approximal carious lesions were performed. Among 250 dentists surveyed, 201 responded (response rate 80.4%). Overall, 43% (n = 87) and 75% (n = 151) of respondents would place their RTs in enamel for occlusal and approximal lesions, respectively. Dentists with an exclusive practice of paediatric dentistry more frequently would choose a RT in dentine for approximal lesions than did other dentists (p = 0.010). A preparation technique including sound dental tissues was less frequent for occlusal than approximal lesions (n = 31; 15% vs n = 60; 30%). Overall, 75% (n = 151) of respondents used the same restorative material for occlusal and approximal lesions. In general, dentists practising paediatric dentistry in France overtreated lesions on primary molars, which contradicts minimal intervention recommendations. RTs are too often indicated for enamel-confined carious lesions.

Restorative intervention thresholds vary between dentists

Restorative intervention thresholds vary between dentists

Temporary Tooth Separation to Improve Assessment of Approximal Caries Lesions: A School-Based Study.

Radiographic lesion depth should not be used as the single determinant of the restorative threshold for clinically inaccessible approximal caries lesions. Temporary tooth separation is a feasible and effective diagnostic aid for assessment and appropriate management of approximal lesions. In the era of tooth-preserving dentistry, the decision to restore approximal caries lesions must be based on the accurate assessment of tooth cavitation, as the accumulation of oral biofilms in these areas encourages lesion progression. However, lesions radiographically into dentin remain the main threshold criterion for restoring approximal lesions even though most of these lesions may not be cavitated. A school-based clinical protocol for temporary tooth separation (TTS) was developed to improve visual-tactile assessment and management of clinically inaccessible approximal lesions. TTS data retrieved from electronic health records were used to correlate radiographic lesion depth and surface cavitation status with lesion location and the patient's caries risk and to evaluate the effectiveness of TTS as a diagnostic aid for approximal lesions. Of the 206 lesions assessed, 66.5% (n=137) were located in the maxillary arch, 56.6% (n=116) in distal surfaces, 61.3% (n=114) in premolars, and 21.5% (n=40) in molars. After tooth separation, 79.6% (n=164) of the lesions were diagnosed as noncavitated, including 90% (n=66) of the lesions radiographically at the inner half of enamel (E2) and 66% (n=49) of those at the outer-third of dentin (D1). Logistic regression analysis using E2 and D1 lesions showed no significant association between lesion depth or cavitation status with lesion location and caries risk. TTS is a feasible and effective diagnostic aid for the assessment and appropriate management of approximal caries lesions. There is a need to reevaluate the use of radiographic lesion depth as the single determinant of the restorative threshold for clinically inaccessible approximal lesions.

Restorative intervention thresholds and treatment decisions of general dental practitioners in London.

Introduction Minimally invasive dentistry has been promoted as the contemporary approach to the operative management of dental caries. Operative intervention should be undertaken on cavitated lesions which are actively progressing. However, there may be large variability in the restorative intervention thresholds and care plans of general dental practitioners (GDPs).Aims To investigate restorative threshold and treatment decisions for occlusal and proximal carious lesions in a cohort of GDPs in London. To investigate potential differences based on number of years since graduation and attendance on a caries management course.Materials and methods A previously used, validated caries questionnaire was distributed to foundation dentists, general practice dentists and practising educational supervisors in NHS London dental practices. Results Two hundred and seventeen GDPs participated in the study. For occlusal lesions, nine (9.1%) newly-qualified dentists selected to intervene surgically on lesions confined to enamel, compared to 24 (29.8%) dentists who have been qualified for more than five years (p <0.05). In addition, a greater number of dentists who had attended a training course were more likely to do a minimally invasive preparation for a proximal lesion (38.2%), compared to 19.8% of those who had not (p <0.05). The majority of all participants (74.2%) chose to restore a proximal lesion using resin composite. Despite this material choice, 58.5% of those graduating within five years opted to prepare a traditional Black's class II cavity. Conclusion A practitioner's restorative intervention threshold and their choice of treatment appears to be negatively affected by the number of years post-qualification, and positively influenced by attending a caries management course.

How to combine two methods to restore populations cost effectively

AbstractEcosystems worldwide have become degraded due to global change, and therefore, restoration of these ecosystems is critical for the prolonged provision of ecosystem services. Specifically, major restoration efforts are directed toward the restoration of key species that provide important services and functions. There are often several alternative methods to restore a species population, such as the reintroduction of its individuals, improvement of its habitat quality, and removal of competing invasive species. However, these methods can be expensive, and hence, it is important to determine how to cost effectively combine them over time. In this paper, we use optimal control theory and we find a general rule of thumb for combining two restoration methods. The general rule, which applies to a wide variety of ecosystems, is that cost‐effective restoration entails one of the following two strategies: (1) using a single method until the system approaches a “restoration threshold” or (2) combining both methods to approach an “investment benchmark,” which is a certain configuration of the system that does not depend on the system's initial state. After either the restoration threshold or the investment benchmark has been approached, investment should stop and the system should be left to recover naturally. Therefore, finding the restoration threshold and the investment benchmark is key for guiding effective restoration, and we demonstrate a simple method for finding them.

Dystrophin Threshold Level Necessary for Normalization of Neuronal Nitric Oxide Synthase, Inducible Nitric Oxide Synthase, and Ryanodine Receptor-Calcium Release Channel Type 1 Nitrosylation in Golden Retriever Muscular Dystrophy Dystrophinopathy.

At present, the clinically most advanced strategy to treat Duchenne muscular dystrophy (DMD) is the exon-skipping strategy. Whereas antisense oligonucleotide-based clinical trials are underway for DMD, it is essential to determine the dystrophin restoration threshold needed to ensure improvement of muscle physiology at the molecular level. A preclinical trial has been conducted in golden retriever muscular dystrophy (GRMD) dogs treated in a forelimb by locoregional delivery of rAAV8-U7snRNA to promote exon skipping on the canine dystrophin messenger. Here, we exploited rAAV8-U7snRNA-transduced GRMD muscle samples, well characterized for their percentage of dystrophin-positive fibers, with the aim of defining the threshold of dystrophin rescue necessary for normalization of the status of neuronal nitric oxide synthase mu (nNOSμ), inducible nitric oxide synthase (iNOS), and ryanodine receptor-calcium release channel type 1 (RyR1), crucial actors for efficient contractile function. Results showed that restoration of dystrophin in 40% of muscle fibers is needed to decrease abnormal cytosolic nNOSμ expression and to reduce overexpression of iNOS, these two parameters leading to a reduction in the NO level in the muscle fibers. Furthermore, the same percentage of dystrophin-positive fibers of 40% was associated with the normalization of RyR1 nitrosylation status and with stabilization of the RyR1-calstabin1 complex that is required to facilitate coupled gating. We concluded that a minimal threshold of 40% of dystrophin-positive fibers is necessary for the reinstatement of central proteins needed for proper muscle contractile function, and thus identified a rate of dystrophin expression significantly improving, at the molecular level, the dystrophic muscle physiology.

Approximal and occlusal carious lesions: Restorative treatment decisions by California dentists

BackgroundInvestigators use questionnaire surveys to evaluate treatment philosophies in dental practices. The aim of this study was to evaluate the management strategies California dentists use for approximal and occlusal carious lesions. MethodsIn May 2013, the authors e-mailed a questionnaire that addressed approximal and occlusal carious lesion management (detection and restorative threshold, preferred preparation type, and restorative materials) to 16,960 dentists in California. The authors performed a χ2 statistical analysis to investigate the relationship between management strategies and respondent demographic characteristics. ResultsThe authors received responses from 1,922 (11.3%) dentists; 42.6% of the respondents would restore approximal lesions at the dentinoenamel junction, and 33.4% would wait until the lesion reached the outer one-third of dentin. The preferred preparation type was the traditional Class II preparation. Dentists who graduated more recently (20 years or less) were more likely to delay approximal restorations (P < .0001); 49.9% of the more recent graduates would wait to restore an occlusal lesion until the outer one-third of dentin was involved, and 42.6% would restore a lesion confined to enamel. ConclusionsThere is wide variety among California dentists regarding their restorative treatment decisions, with most dentists restoring a tooth earlier than the literature would advise. More recent dental graduates were more likely to place their restorative threshold at deeper lesions for approximal carious lesions. Practical ImplicationsClinical evidence shows that noncavitated carious lesions can be remineralized; therefore, early restorative treatment may no longer be necessary or appropriate. Noninvasive and minimally invasive measures should be taken into consideration.

Grassland degradation and restoration: a conceptual framework of stages and thresholds illustrated by southern Brazilian grasslands

Land degradation is a complex concept that integrates different aspects, including changes in soil conditions, biodiversity, productivity and socio-economic implications, compared to a reference state. We propose a new conceptual framework to analyze degradation stages and restoration thresholds in species-rich natural grasslands. The framework integrates different degradation stages with their respective thresholds and describes key processes of land-use change that lead to certain stages and thresholds. Specifically, we discuss two scenarios of grassland degradation, i.e. unsuitable grassland management and complete change of land use, sometimes followed by spontaneous recovery. We illustrate the framework with the case of south Brazilian grasslands, which are rich in biodiversity, but suffer from a series of degradation processes and are poorly considered from a conservation perspective. The conceptual framework can be applied by studies on degradation and restorability of tropical and subtropical grasslands after changes in management or transition to other land use; it will facilitate decisions on alternative management and conservation.

Restorative treatment threshold reported by Iranian dentists.

To study Iranian dentists' conceptions of the earliest stage to place a restoration on proximal caries lesions. A questionnaire survey was carried out among the participants of two annual dental meetings in Tehran, Iran, in December 2004 and July 2005. The questionnaire was filled in anonymously and returned during the meeting days. The questions covered two patient paper cases with schematic drawings of the radiolucency of proximal caries lesions according to bitewing radiographs from 20-year-old patients: one high-caries case and one low-caries case. Dentists' gender, age, working experience and place, and participation in continuing education served as background data. In total, 1,033 dentists completed the questionnaire, 63% were men. Statistical evaluation was by the Chi square test and logistic regression. Respondents were to select from four alternatives the earliest stage in the progression of a lesion at which they would intervene by restorative treatment. For the high-caries case, 77% of the respondents chose to restore a caries lesion confined to enamel; activity in continuing education was the strongest factor (OR = 1.4) to explain dentists' restoring a lesion no earlier than in dentine. For the low-caries case, 32% chose to restore a lesion in enamel. Restoring a lesion no earlier than in dentine was more likely (OR = 1.5) among female dentists. Iranian dentists seem to prefer early restorative intervention, which indicates a need to focus on the preventive aspects of caries treatment both in dental curricula and in continuing education.

Changes in Occlusal Caries Lesion Management in France from 2002 to 2012: A Persistent Gap between Evidence and Clinical Practice

A survey conducted in 2002 among French general dental practitioners (GPs) showed variations between treatment decisions and a tendency towards early restorative intervention for caries. The aims of the present questionnaire survey were to investigate, among a random sample of 2,000 French GPs, the management decisions for occlusal lesions in 2012 and to compare the results to those obtained in 2002. The response rate was 41.9%. The majority of the respondents (60.7%) would postpone their restorative decisions until the lesion was in the dentin, based on clinical and radiographic examinations. Almost 68% of the respondents suggested that the cavity preparation should be limited to the lesion (vs. a preparation extending to the occlusal fissure), and 81.6% chose composite as restorative material for the earliest lesion requiring restoration in a 20-year-old patient with his/her caries risk factors under control. Statistical analysis (χ² and logistic regression) showed that the management decisions were influenced by certain demographic characteristics (gender, clinical experience and participation in cariology courses). When comparing the 2002 and 2012 responses, it appears that even if French GPs still tend to intervene surgically for occlusal lesions, which could benefit from noninvasive care such as therapeutic sealants, the restorative threshold has been delayed to later stages of carious progression (p < 0.0001). Moreover, the 2012 respondents were less likely to open the fissure system than the 2002 respondents (p = 0.032), and less amalgam restorations would have been placed in 2012 (p < 0.0001). Furthermore, the results showed that the variability observed in 2002 toward caries management decisions was persisting in 2012.